<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343601817
Report Date: 04/08/2022
Date Signed: 04/08/2022 01:52:24 PM


Document Has Been Signed on 04/08/2022 01:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:CASTORI STATE PRESCHOOLFACILITY NUMBER:
343601817
ADMINISTRATOR:CHOW XIONGFACILITY TYPE:
850
ADDRESS:1801 SOUTH AVETELEPHONE:
(916) 566-3420
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:45CENSUS: 11DATE:
04/08/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Fong KhamnivongTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Alize Tillery arrived at the facility at approximately 1:30 PM, to clear deficiencies cited on 03/09/2022. LPA met with Director Fong Khamnivong. LPA observed 11 children, supervised by 6 staff.

During today's visit, LPA reviewed children files; children files were observed to be complete. Director is aware of which documents are to be kept in all children's files. LPA was also provided a complete Director packet.

Today, LPA Tillery is clearing citation 101221(b)(8)(C) and 101212(b).

In the areas that were observed, no deficiencies were cited. An exit interview was conducted and a Notice of Site Visit was provided.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1